Cognitive Therapy

Cognitive therapy (CT) is more commonly called cognitive behavioural therapy (CBT). This is because it's almost always practised with behavioural therapy principles.

What is cognitive therapy?

Cognitive therapy is all about learning how our thoughts create our moods.

In CT, we discover that we all have inherent tendencies to certain negative thoughts that evoke unhappiness and disturbance – especially in response to particular trigger situations.

Once we accept that fact, we can learn to spot these negative thoughts as they arise and then challenge and re-think them.

Who developed it?

Cognitive therapy was first developed in America around the middle of the 20th century.

Its main pioneer was Aaron Beck, a medical doctor, psychiatrist and psychoanalyst who came to believe that he was not getting enough improvement in his patients through analysis.

He realised that negative thoughts were often holding back patients – such as: 'I'll be hopeless at that', or 'I'm unlovable', or 'I'm stupid'.

Another therapist, Albert Ellis, was also coming to much the same conclusions about patients' negative thoughts and their tendencies to 'catastrophise' or 'awfulise'.

Ellis's work with patients also became a form of cognitive therapy, now more commonly called rational emotive behaviour therapy.

Both Beck and Ellis drew on the teachings of the stoic philosopher Epictetus, who believed that: 'It's not things that upset us, it's our view of things.'

Case study

Take Tina, who worked in publishing. She met her boss in the lift and said 'good morning', but her boss didn't reply.

In no time Tina was thinking thoughts like:

  • my boss doesn't like me
  • no-one likes me
  • I'm going to lose my job
  • life is hell.

These thoughts were responsible for Tina plunging into a low mood.

Tina didn't for one minute consider that her boss may not have heard her or that her boss might have been pre-occupied with her own thoughts.

Tina realised she was always getting upset about such situations, and she started therapy to try to sort things out.

In a few weeks, she came to understand how negative thoughts were causing her to be unhappy. Tina also learned how to spot when she was jumping to conclusions in this way.

Then, with help, she was able to challenge these negative thoughts by looking for evidence to see if they were really true.

They were rarely true, so Tina was only upsetting herself by thinking in such a way. This is what many of us do.

Cognitive therapy teaches us to stop thinking so negatively, to challenge untrue thoughts and to replace them with more rational and healthy ones

Will CBT work for me?

The benefits of cognitive therapy are well researched.

CBT suits individuals with all sorts of problems – including depression, anxiety, phobias, difficult relationships, obsessive-compulsive disorder and eating disorders, especially bulimia nervosa.

For many patients it has been found to be more helpful than any other kind of treatment, including antidepressants.

How available is CBT?

Recent years have seen a real injection of NHS funding into cognitive behaviour therapy.

At the end of 2004, the National Institute for Clinical Excellence (NICE) published a report saying that CBT should be one of the preferred routes of treatment for mild to moderate depression.

As a consequence, an initiative was launched to train a further 10,000 CBT therapists to meet the resource implications of their recommendations.

This does mean there should be more therapy available on the NHS for anyone now considering CBT. There are also a growing number of therapists, who additionally work in the private sector.

How can I access CBT?

If you are hoping to get CBT on the NHS, you should speak to your GP to see if he or she will refer you.

Many GPs and their nurses are now also working with their patients using supervised self-help CBT material – including books, CD-ROMs and websites.

One aspect of this kind of treatment is commonly referred to as computerised cognitive behavioural therapy.

There are two particularly good programmes:

  • 'Beating the blues' for mild to moderate depression
  • 'Fearfighter' for the management of panic and phobia.

NICE recommends both of these programmes, and more GP practices are offering this kind of treatment. It can be done at home by anyone and does not require previous computer expertise. Ask if your local practice offers this service.

There's also a free online service that anyone can access – simply by registering. This was devised by one of the country’s leading exponents of CBT, psychiatrist Dr Chris Williams. The website is called Living Life to the Full.


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